WTC Loss Tests Mental Health Care Web

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Potential repercussions of the Sept. 11 terrorist attacks on New Yorks World Trade Center and the Pentagon are many and varied.

Madeleine Estabrook, partner in the Boston headquarters of national law firm Edwards & Angell, feels a national epidemic of post-traumatic stress syndrome cannot be ruled out as one of them; and, she suspects the managed care industry is not up to the task of handling such a possibility, mainly because of a nationwide dearth of mental health-care practitioners.

“How are we going to service the population, how are we going to make sure theres sufficient access for everyone who may need services now or later or for a significant period of time,” Estabrook says.

“Most communities respond with clergy, schools, community support, but true mental health services need to be received from the medical community which may not have the resources.”

Estabrook, whose concentration is in health-care law, says that although she is not in a position to say definitively that the nation is in the midst of an epidemic, the Senate has heard testimony by university professors of psychiatry and mental health-care professionals suggesting that such an outcome can be expected, based on the aftermath of the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City.

A Sept. 18 press release from ComPsych Corporation, a Chicago-based provider of behavioral health and work-life services, lends support to Estabrooks theory of a substantially increased need for mental health services. According to the release, the company experienced a 1000% spike after the attack.

“We anticipate these numbers to grow as the reality of the situation continues to set in,” says Dr. Richard Chaifetz, CEO of ComPsych. “The ramifications of this event will change our countrys workforce forever.”

But Dr. Jonathan Book, executive vice president and chief medical officer for Magellan Behavioral Health, whose parent company is Magellan Health Services Inc., Columbia, Md., one of the nations largest providers of managed behavioral health services, does not foresee an increased demand for mental health-care treatment great enough to overburden the system.

“In terms of the magnitude of this tragedy this is an unprecedented event, so we cant predict what to expect based on our experiences with local events alone,” Book says. “We are not seeing a national epidemic.”

He says the country is responding nationally in a number of ways, ranging from anxiety and depression, for which most people dont seek professional help, to more severe, pathological reactions, including post-traumatic stress syndrome.

Because reactions occur in phases, it is unlikely an epidemic would be evident in the immediate future anyway, he says.

The first stage is the need for stress management. Subsequent to that is grief and anxiety, “the shaking of security that all of us feel after this attack, and then down the pike, which has yet to emerge, is the question of which of the anxieties and grief will turn into pathological reaction,” Book says.